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HomeMy WebLinkAbout040-1008-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County -' - -'- St. Croix Safety and Byilding Division INSPECTION REPORT Sanitary Permit No: 506121 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: Woodmansee, Rick Tro , Town of 040 - 1008 -80 -000 CST BM Elev: Insp. B BM Descri tion: '' ee Section/Town /Range /Map No: �"D • a t' ' D 14L .4 03.28.19.38E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark .� /D /• O /00.0 Dosing Alt. BM o 1-0 dd Aeration Bld r >' /T�' 7 a' Jam /a. D G Holding St/Ht Inlet •U D St/Ht Outle; '' � O TANK SETBACK INFORMATION / /Z• g' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / 9Q ,f� Dt Bottom Dosing lo w Header /Man 3 Aeration Dist. Pipe 4t V im Q„yf J3.9 D Holding Bot. Syete m / _ Final Grade Q�,y PUMP /SIPHON INFORMATIO `hcdr j /J• 0 / Manufacturer Demand t Cover GPM r7 ri /. Model Number Z' TDH Lift Friction Loss r yfllm Head TDH Ft Forcemain Lengt Dia. Dist. to Well ! ' ^ 7 2S / SOIL ABSORPTION SYSTEM Q. (� o BED /TRENCH Width 3; Length ,r No. Of Trenches PIT DIMENSIONS No. Of Pits niide Dia. Liquid epth DIMENSIONS ( / SETBACK SYSTEM TO P/L BLD WEL LAKE /STREA EACHI M u a urer: / Y INFORMATION CHAMBER Typ f System: ,� ©/ �� Model Number: DISTRIBUTION SYSTEM Header /Manifold ist ib i �,t. s( ize x Hole Spacing Vent to Air Intake — ipe(S „►--- / Length Dia Length Dia Spacing _ C C 7 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over ,� L Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center L ') /� Bed /Trench Edges Topsoil Yes No Yes No % COMMENTS: (Include code discrepe ies, persons present, etc.) Inspection #1: 15:1 / Q Inspection #2: Location: 597 White Oak Hudson, WI 5401�6� (NW Q X 1/4 NW1 /4 3 T28N R19W) metes & bounds Lot 23 � / Parcel No: 03.28.19.38E 1.) Alt BM Description = I °r OF 6th. W "", vl - jroi k 2.) Bldg sewer length = f ����,���-�• amount of cover = ` C rC w ►N ►l tff[ -- �� a•Clc� Plan revision Required? Yes `moo Q U7 s� Use other side for additional Information. J Date Insepctor's Sig ature Cert. No. SBD -6710 (R.3/97) _ ggu; n� cornmerce.wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 i s c o n s 1 n Madison, WI 53707-71 62 Sanitary Permit Number (to be filled in by Co.) Department of Commerce sap low 1 Sanitary Permit Application State Transacti n Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate vern ent unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned WT Project Address (if different than mailing ga adddress) submitted to the Department of Commerce. Personal information you provide may be used for con y p urposes in accordance with the Privacy Law, s. 15.04(1 )(m ), Scats. 1. Application Information - Please Print All Information Property Owner's Name Parcel # b RECEIVED 1,,ZZ c,e G :Zd - Property Owner's Mailing Address Pr erty Location s yT .�,- �,� . �� MAR 2 6 2007 Govt. Lot City, State Zip Code Phone Number � y,, X y. Section c ST. CROIX COUNTY (circle one) Sye�t/ , s 11. Type of Building (check all that apply) � N; R � E or r T c or 2 Family Dwelling - Numher of Bedrooms i Is 7"c..G� Subdivision Name i W Block # Ax__� � -6- 9 3 ❑ Public/Commercial - Describe Use ' WPL*_rr� V / SST O a❑ city of ❑ State Owned - Describe Use �Od CSM Number ❑ Village of I ti Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ()Noui� .� �Q��C 1� 0 N IV. Type of POWTS System /Component/Device: Check all that appl ANon- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitablc soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ment Area Information: c , - zr ¢ k - Design Flow (gpd) Design Soil Application Rate(gpdst) l Area Required s Dispersal Area Pr posed (st) System le+�� VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a v o v New Tanks Existing anks w e d 4 A ` p. U Septic or Holding Tank / y V D Dosing Chamber f ,1 e , 6 ` , c ✓{ VII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWYS s wn on the attached plans. Plumber's Name (Print) / Plumber's Signature MPRS Number Business Phone Number /,� +/! e�G. �J = `^ae V ems' K �� Plumber's Address (Street, City, State, Zip Code) J G. _ i fv VIII. ount /Department Use Onl Approved ❑ Disapproved Permit Fee Date I sued ssuing A ent ign ure r ❑ Owner Given Reason for Denial . tl � ,ApprovaUReasons for Disapproval U ZytS7 _ 1 Septic tank, effluent filter and hi t _ / cn, dispersal cell must all be serviced / maintained as per management plan provided by plumber- 2. All setback requirements must be maintained aS per applicable c o comp tl plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 SOT oT 23 �. -54 lie sill a � Il e.�� - WL Z I-Pk d C �^ yzi /y /� �"Fc .3 72f X q 0) / 1,6)T f /Y 2 -3 EV P �S a s• i ,- � fat ✓a y,���ll [e. GOULDS PUMPS Submersible Effluent Pump _ 3871 EP0 EP0 r nnnn�irur�r.�r — — -- -— — rrrnrrlr APPLICATIONS • Fully submerged in high s EPOS Impeller: Thermoplas- 0 Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. caeadw SwWarsk As;0cWd0M1 • Heavy duty sump math models include • Water transfer Mechanical float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is 50 9001 Iliq;islered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '/4• maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet pump out vanes for mechanical • Discharge size: 1' /2" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 1041 (40"C) continuous METE FEET 1401 (6000 intermittent. ^ • Fasteners: 300 series 10 _.. , _.. stainless steel. f • Capable of running 30 dry without damage to $ 2.5 FT I . components. _...... _..._ . $ z _ Motor: s • EPO4 Single phase: 0.4 HP, 5� 6 20 _ __._. 115 or 230 V, 60 Hz, 1550 RPM, built in overload with s automatic reset. a 4 15: EPOS • EP05 Single phase: 0.5 HP, 115V, 60 Hz, 1550 RPM, '' 3 10 built in overload with 1 EPO4 automatic reset. z • Power cord: 10 foot s ... _ .. standard length, 16/3 1 STOW with three prong _ grounding plug. Optional 20 0 00 10 20 30 40 so GPM foot length, 16/3 S1TW with three prong grounding plug � (standard on EP05). 0 2 4 6 8 10 12 m'/h CAPACITY Goulds Pumps ® 2000 Goulds Pumps ITT Industries Effective February. 2000 83871 SEPTIC TANK PUMP CHAMBER CROSS SE CTION AND SPECIFICATIONS 4" CI VENT PIPE 12 2" MIN. ABOVE GRADE E WEATHERPROOF >_ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED COVER FRESH AIR INTAKE WITH CONDUIT M 1 OCK& FINISHED GRADE WARNING LABEL 4" CI RISER � 4" MIN . < < t , WATER TIGHT SEALS GAS- , _ TIGHT �, \APPROVED A SEAL 1 JOINTS WITH PPROVEO ' ALM APPROVED PIPE a B ' IPE 3' 3 O S NTO SOLID � 4N SOLID SOIL 1 OIL PUMP OFF ELEV . FT. OFF ** RISER EXIT PERMITTED ONLY D IF TANK MANUFACTURER z HAS APPROVAL r 3" APPROVED, BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: e NUMBER DOSES PER DAY: TANK SIZES: SEPTIC 1cd�er GAL. DOSE VOLUME INC L s�'f GAL. DOSE �, �a _ -- ALARM MANUFACTURER: ��P�v n� CAPACITIES: A = INCHES = 3ey GAL. MODEL NUMBER: = y 2 INCHES = 3 'Q GAL. SWITCH TYPE: B PUMP MANUFACTURER: c' C $ INCHES = GAL. MODEL NUMBER: �",r9 a �/ D = (o INCHES = _ y�p GAL. SWITCH TYPE:��� REQUIRED DISCHARGE RATE _ `�(1 GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23' WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . • . • • . . . . . . _2W FEET + FEET FORCEMAIN X ; 2�GDFT /104 F T. T.OTAL DYNAMIC 3S FR = _l_ .7 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER LIQUID b 'I`I ' D" l 'eK SIGNED: �� LICENSE NUMBER: DATE: l' 1/88 Wisconsin Departrr1e "t of Commerce EVALUATION REPORT l Division of Safety and Buildings Page ---L of in accordance with Comm 85. Wis. Adm, Code T Attach complete site Plan on paper not less than 8112 x 11 County —complete inches in size. plan must /- include, but not limited to: vertical and horizontal reference point (13M), direction and Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Paw i.D U — / Please Print all Information. ReviTwik by Date Personal information you Provide may be used for secondary Purposes (Privacy Law. C, 15.04 (1) (m)). 3 O� Property Chimer E C E I tion -Oc Qooc� Vv`�+R � e Govt. Lo owner s Ma t LAj Sf4„(fl,l� J4 S T Z N R E {or� Property tting Address APR 0 3 2 �L� # lock # s ibd. Name or CS S k 4e- l b IX CO E Rojekd ateP � Cy ❑ Village 0 own re -a' 1 Ste/ & Q�cl ❑ New Conabvcrtion USe :`M Residential / Number of bedrooms _ Code derived design How rate O PRaplacement /I ❑ Public or commercial . Describe: GPD Parent material (�(' a t Few G "\ Flood Plain elevation if e ��ticns: applicable C3 Borft iCJ Pit Ground surface elev. ft Depth to limiting factor f in. 1 Depth Dom Color Soil ication Rate Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Efffl t 'Etf#2 o - i� S' C Zka6 41— Sic I r► YI'� r C _ 5 / S os t r C) Boring Pit Ground surface elev. � G U R. Depth to limiting factor / / S i Soli Applicallion Rate Horizon Depth Dominant Cot Redox Description Texture Structure Consistence Boundary Roots GPDlfF in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z )l— 4/ �c( r C �. S vK Efi> asnt #1= BOD > 301 220 mg& and TSS >30 _< 150 mgt ' Eflluent #2 = BOD < 30 � and TSS < 30 mgt � Name Print) CST Address Date Evahu Ion CAr>duded T elephone Proms, Owner G16 od" ti-5e e. parcel ID 1 & -0 00 Page � a ® Borirp # ❑ Boring Pit Ground surface elev. ft. Depth to limiting favor in. Sod Applicatlon Rate horizon Depth Dominant Coke Redox Description Texture Structure Consistence Boundary Roots GPDNP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C Z 2 � - ,'c S F � # C] Boring ❑ Pit Ground surface elev. _ - - _ ft. Depth to Ik Wting factor _ __ _- in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. CoWr Gr. Sz. Sh. 'EW1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to fkniting factor � in. Sal Rate Horizon Depth Dorrunant Color >,edox Description. Texture Structure Consistence Boundary; Roots GPDIft; in. Munsell Qa, Ss. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 ' Effluent #1 = SOD > 30 = 220 nvk and TSS >30 150 nvk ' Eftent #2 = SOD, 130 mpll. and TSS 130 nplL The Department of Commerce is an equal opportunity service provider and employer, If you need assistance to access services or need material in an alternate format, please contact the department at 608.266 -3151 or TTY 608- 264 -8777. se04030 (Lim) a PAO ` ,.-.,0 M A 1 NAMIR W064 Un a TIC iPTION �'WI /adiv Tz N R F.(OR /O r EcwLES 1" � "7 HM I l:LiRVATION C). IBM 1 Dgar-ItIPTION 13M 2 ELEVATioN IBM 2 DESCRIPTION SYSYIKM ELSVATI0 S YSTEM TYPS / 54 cP Dr Z i 1 t r D oci � c t 1.,; C f��r "iIGiNA'I'UR! �1' DATE ST CROM cove! w SHMC TANK MAWnWANa AOREOMM AND p OWNSRSHtt CP.R17P'ICATION FORM O� n I s ocdr.ag•zrc G - M"m A"m Tq Oct D.� c fta �✓',, t p Addlm S ? , z .F' U '' // t Nwi6olios a o"iI dims lMa.is� Dapwssast /or .aw awstm D Sf v•- i ecrP— d'O - coo 0 b 74CR,� 14opeety LoeMioo S/., LV,�✓ 'Y., Sec. T N R,.Z± -W. Tows of T y �,,�►� Cwdgbd Sw"y map • vohl - pw p w. om" D"d r 0 D 6 z = _ - v obl 19 Q3 - pop p r� Spec hove D pee tai no Lot lbw idemibbie IN Tw 13 no .oearaoira■re.. ter. 4deaywaoeoWdworitbiw�... �. sr7a�sloti ..aew�s.trop�er,ni.�e.oeoa e..alalt atpnslpi� oat r aaPtfa r.it awt rs ya.w aasati if aawNd by a tioaawdMnPer. a►bc � prt iro dr arMwu aas.ityal iMe redas at r aopde ts*.o. 1nal.wa � i •o waar digaat ayas�a Tba Paapee S Owu NOW W SAW t • sc Cmda im* Dqwhww a owdee lieu hm slpW by dw o w asd br s Il *a Y •l bar. ot oiPbs. Mraea5mwmdp. mWv ilyig (Q fWQM4*ewsalaw.ler61190187d= b k pmw .! - - 16 oosilfos asdfw m aft irpoedas.sd SIM46 d (if woomowk r ngide wk b Moo dw1 W #A of dWp. 90% d w mdwdond baw wad di. abawe aagaiw.a..ea a.d s ee w an w:lbs > w aawge di�paaal •rte wii dw mmdwda salhdk bo i. as aet by r Dop""stQ o.ad r D o[Nwd 1ta.woaa dole of wiaoo.aia andionias ft dlat � �e � br eam b mwhwimd and bo amyl ad ow numd a r St. C�aivc Coasty Zosi o q OQioe wjbb 3o � i�ef 1ba re �"11' M. �3 0 ""I" or A>RLWANT a►Te I (w) o4wW rt 41 ONO= "& = dda 110= m Nu w ft beet of my {aas) bsooriadpe. 1 (wo) am (an) ie ow.eata) at MMpoetr -Gdabvv%by Neao of. WON" decd nooMod is RegiOw of Dada Ofilee. Of DATE �•�••• Any' 6 - I' m rt b aai►aatwre.ly Wy WW* is dr wsilery Pan* baiq aarwlod by dw ZMAt Dom. •• «•• " Indlak wldi Wa appOnew . a sbwwd wro NO dad Aram dw bgilm of Dee* offte a c" et *w aa1i1W weer N* if rdeeeeoe is made in On wernwo dad POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page (_ of 2— FILE INFORMATION SYSTEM SPECIFICATIONS E e� Septic Tank Capacity Q ©© a l ❑ NA # a Septic Tank Manufactu ' ❑ NA _ _ LrJ r �.5 DESIGN PARAMETERS Effluent Filter Manufacturer (� ❑ NA Number of Bedrooms Effluent Filter Model A ecl ❑ NA Number of Public Facility Units NA Pump Tank Capacity 16 11 4 al ❑ NA Estimated flow (a e} Pump Tank Manufacturer � ❑ NA --- -- - g X0 gall day p Sey Desig,i flow (peak), (Estimated x 1.5) 5"Q _ gal/d Pump Manufacturer �� 13 NA Soil Application Rate L9, — 7 g al /da /W Pump Model J3 A ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L D NA ❑ Mechanical Aeration 0 Wetland T otal Suspended Solids (TSS) 5150 mg /L ❑ Disinfecti n ❑ Other: Pretreated Effluent Duality Monthly average Disper Cells) ❑ NA Biochemical Oxygen Demand (HOD 530 mg /L - Ground (gravity) E3 In -Ground (pressurized) Total Suspended Solids (TSS) S30 m91L NA ❑ At -Grade ❑ Mound Fecal Col(form (geometric mean) " /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: 13 NA In= ❑ NA Other. _._Y__ ❑ NA "Values typical for domestic wastewater and Septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankis) At least once eve month y s) (Max)onunt 3 ears) 13 NA ever earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal call(s) At least once every: months) (MaxMwm 3 years) ❑ NA 3 W_ earls} Clean effluent filter S !✓�� �1} --- At least once every months) ❑ NA _ ,�year(s) Inspect pump, pump controls & alarm At least once every: ;,�.. 13 months) ❑ NA 1011 ❑ years) sh laterals and pressure test At least once every: ❑ month(s) ❑ NA O ear(s) her: At least once every: e � ( th(s) ❑ NA her: C3 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 pending of effluent on the ground surface. The dispersal call(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 (Y3) 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 512 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. eco� en4949oulway u!atl039!M "IE1 1 P fZ) 'It 1d9'66 F'us IOVIIIII IIIg1(r1Lt'C8 wujo:) falda(la ql!m aoueydwou ui p944ejv seen juawn0op s "�i'j OU04 6uo IQ - -L DWON ewel�l Alla0Hli1V Atl01V1Mau 1MJ01 Itl3dwnd) N01VH3d0 aN101AUS 30V1d3S MT, WON OWON lI3NId1N) W S AA id _. 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I 4 91 1 •�.', �'y1��C'': �� 1 S a P. u.� 1 .r ,i .. .±.• r. . r �3 ;, j1.n a • �r P r D r> l'4, O .i w p p p p N O N r 4i '•� ri. �{ • 4\ \ J_ J/ Y0. to w 003 toe 1 9.03' N J tar4oe ` \ • N war A r c o a p p 240.05' . . . . . /. rNro 1 \M i• \ f O u 01 y / / N J • J G O♦ r g w / / H ♦.O A l/ \ �0 0+ 1 .ef /N09 $5' 30"W - IN �E = ow .. _ ',' • x ' 2639.29' Y.\ 1... I / � O °.' to t .ii. • v ✓_) , N ••' A la. i t 4, 'G •b 'OO�'tt - i I W �J• r a D 9 ''o:•• o•d J•b . a• yr .o r ' ef0 X m u � ♦ iJ 1 /iY />n. O� r 4 in 0 WEST f' Y J ♦ bJ -qv, ' lr 'y °�• i N N U ,9 \ V S , ' :0 ' ' �ti • V 9L 5901 __ --p e . 'N , { Q a - ` " EAST . V ^ 699 2 � N H � ' •Iq •4� • .. s u u 1 3:fs N ♦ i. J - 77 \ J p p ° a A fi •• of U O u U � • J '1 v �-� p ,a �; :• f y r owN R�,p�'J. ' 1 N) • 8 „ Oy 7- Parcel # : 040 - 1 008-80 -000 04/03/2007 03:13 PM PAGE 1 OF 1 Alt. Parcel #: 03.28.19.38E 040 - TOWN OF TROY 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 - WOODMANSEE, RICHARD R & MARY M RICHARD R & MARY M WOODMANSEE 597 WHITE OAK DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 597 WHITE OAK DR N SC 2611 HUDSON SP 1700 WITC t YI Zit-. Legal Description: Acres: 5.000 Plat: N/A -NOT AVAILABLE SEC 3 T28N R19W 5AC NW NW COM 585'S & Block/Condo Bldg: Z 3 507.58'E OF NW COR SEC 3, N 30 DEG W 168.95 FT N 13 DEG E 281.49', N 57 DEG E Tract(s): (Sec- Twn -Rng 1601/4) , 0 421.99'S 32 DEG E 365', S 57 DEG W r/D 630' - POB ��l- 3''/ 03- 28N -19W q 7 ,)-o- - 71i 73 1 7 ' rfto q7 -- Notes: - -�''Parcel History: 3 Date ry Doc # Vol /Pag —1 Tyl���3_ � G f yyl 2 06/04/2002 680762 1903/558 V"*Yh t- _W ¢ � r � {� 07/23/1997 804/187 K ��'` 07/23/1997 _74247-� 07/23/1997 648/115 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 71,500 168,800 240,300 NO Totals for 2007: General Property 5.000 71,500 168,800 240,300 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 71,500 168,800 240,300 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 113 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 020- 1104 -10 -000 04/0312007 03:13 PM PAGE 1 OF 1 Alt. Parcel #: 34.29.19.412E 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 - WOODMANSEE, RICHARD R & MARY M RICHARD R & MARY M WOODMANSEE 597 WHITE OAK DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.140 Plat: N/A -NOT AVAILABLE SEC 34 T29N R19W SW SW TRIANGULAR PARCEL Block/Condo Bldg: LYING ALG S LN SW SW AS IN VOL 475 PG 71 ORD Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 06/04/2002 680762 1903/558 WD 07/23/1997 804/187 07/23/1997 742/478 07/23/1997 742/477 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 0.140 3,200 0 3,200 NO Totals for 2007: General Property 0.140 3,200 0 3,200 Woodland 0.000 0 0 Totals for 2006: General Property 0.140 3,200 0 3,200 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 i V 1 9 0 3 1 5 5 3 13 STATE BAR OF WISCONSIN FORM 2 - 1999 KAA 8 0 7 THLEEN H. . MA LSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., NI This Deed, made between Joel R. Jenso and S M. J enson, RECEIVED FOR RECORD hus and wife, _ _ 06 -04 -2002 9:00 AM WARRANTY DEED - -- EXEMPT 0 Grantor, and Richard R. Woodmansee and Mary M. Woodmansee, husb and w REC FEE: 13.00 -- - - TRANS FEE: 629.70 COPY FEE: CERT COPY FEE: Grantee. PAGES- 2 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area (See Attached Exhibit "A ") Name an eturn Addless 0 P r k (7 [ �r 020 - 1104 -10 -000 p-40- 0 _ Oco Parcel Identification u This i s homestead property. (is) MX00 Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of _ April 2002 * o . Jenso - • Susan M. Jenson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Joel R. Jens and Susan M. Jenson, husband and STATE OF WISCONSIN ) wife, ) ss. County ) authenticated this ay of April 2002 Personally came before me this _ day of i the above named + Kr istina Og TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be n the persos) who executed the foregoing (If not, instrument and acknowledged the same. authorized by & 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED - *BY Attorney Kristina Oglan .2 Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. 1„ rom,ation Prcf —onels comp® "y, Fond du !_se. WI 800 - 655 - 2021 STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2- 1999 U 1903V 559 EXHIBIT "A" A parcel of land known as Parcel 23, located in the NW '/. of NW % of Section 3, Township 28 North, Range 19 West, and in the SW % of SW '/, of Section 34, Township 29 North, Range 19 West, St. Croix County, Wisconsin described as follows: Commencing at the NW corner of said Section 3: thence 585.02 feet South and 507.58 feet East to the Point of Beginning; thence N 30° 30' W feet; thence Northerly 311.42 feet on a 202.00 foot radius curve concave Easterly, the chord bearing N 13° 40' E 281.49 feet; thence N 57° 50' E 421.99 feet; thence S 32° 21' E 365.00 feet; thence S 57° 50' W 630.00 feet to the point of beginning. I