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HomeMy WebLinkAbout040-1277-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487933 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: Twomey, Matthew Tro , Town of 040 - 1277 -90 -000 CST BM Elev: Insp. BM Elev BM Descriptio Section/Town /Range/Map No: t� I a 0 / 16.28.19.1551 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench rk Dosing Uji k,-- s Af t. 7 ( D J 3 Aeration 1 10 gw i� �b v y Holding S t Inlet S 2,9 ion• 3 TANK SETBACK INFORMATION SUHt Outlet S•51 TANK TO P/L WELL BLDG. Vent to Intake ROAD Dt Inlet Z /� Septic / r Dt Bottom Dosing W/ Header /Man. •U q-7. CAA C'Ll Aeration Dist. Pipe / % 6 p G -, S GC(G I l Holding Bot. System 2 •O `1 (o SY \ Final Grade - PUMP /SIPHON INFORMATION 3.14) / n� •O Manufacturer Demand St Co; r 1 GPM Model Number TDH Lift Friction Loss ead TDH Ft Forcemain L Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS --- SETBACK SYSTEM TO P1L BLDG WE L LAKE /STRE LEACHING Mang. r INFORMATION CHAMBER O -!i! h y- Ty Of System: ; 1 6R O 1 / i / U Model Number. t� ... . �/ ,! _ DISTRIBUTION SYSTEM ►� Hder /Mariif d Distribution x Hole Size x Hole Spacing ant to it Intake j , � Pipe(s) lQ , ' / / 3 !' � t �0 h lk� Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over ' r N Depth Over xx Depth of xx Seeded /Sodded xx Mulche Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepancies persons present, etc.) Inspection #1:/ / Inspection #2: / / Location: 396 Cedar Court Hudson, WI 540 (NW 1/4 NW 1/4 16 T28N R1 9W) Eagle Bluff L PQ 19 Q Parcel No: 16.28.19.1551 1.) Alt BM Description = 1 Dp '4 ✓h " C41 � / / ' Q, 2.) Bldg sewer length = /�- �'�IZ�% �ow (Nx�"� - amount of cover= > J - Plan revision Required? ��] Yes [ ', No � i - -'� ! T Use other side for additional information. !��- �_ Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County `/ VA y "'2W W. Washington Ave., P.O. Box 7162 / r r �. c 1 7 sco I sin Mad (6 WI 6 — 7162 Sanitary Permit Npt�b (to be filled in by Co.) Department of Commerce (608)266 -31ST C/` 7 3 Sanitary Permit Applic io tate Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal info ation you provide may be used for secondary purposes Privacy Law, s l�.04(1)(m) o'ect Address (if different than mailing address 4t 3`r CEO C.eal.2T� I. Application Information — Please Print All Information _ ^_ Property Owner's Name P rcel # _ of # Block # A Ff N ��� C . 1 (00 (A EY -_. .is5� �` /L_ , _ "", .)�� Property Owner's Mailing Address Property Location C i ! 11 �/, Section City, State Zip Code Phone Number ! J %a, i j C) (circ ) 1 1 T J N; R E II. Type of Building (check all that apply) S� i �1 or 2 Family Dwelling - Number of Bedrooms t..� s Subdivision Name CSM Number El Public/Commercial -Describe Use SA C P"t-ur - ❑ State Owned- Describe Use ❑City_ ❑Village VTownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) 1 T� IX Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -G and El Holding Tank ❑ Peat Filter El Aerobic Treatment Unit El Recirculating Sand Filter El Recirculating Synthetic Media Filter thing Cha Dip Li ❑ vel -less ipe a 1 , ) V. Dis ersaVFreatment Area Information: 1 — Design Flow (gpd) Design Soil Application (gpdsf) I Dispersal Area Required (sf) Dispersal Ahw.Lroposed s Elevation C f 3 fir` 7, 1 / �, _ i �..' . VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks I Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum is nature /� MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. un /De artment Use Onl pproved Disapproved Sanitary Permit Fee El Owner Si Groundwater Date I sued Is r Agen ign re ps) Surcharge Fee) , 9I �, Owner Given Reaso for Denial ""///fff"' IX. Conditions of Approval/Reasons for Dis4yproval i IYtQinGt a��� YS OWIVE.R_,� � Yl2Q��!YiiC,P/yjCl/KiG2_— Septic tank, effluent filter and lt// ( 0 3• Z , ! dispersal cell must all be serviced / m tai ed�� as per manage ent I n r v i (" �2' 1� 2. All setback requirements must be maintained �� l � as per applicable code /ordinances. Attach complete plans (to the County only) for the s t on paper not I s than 8112 x I inches in size SBD -6398 (R. 01/03)S P; o s .1"A C� t�, j�velopr ont S T 1 - 11,tp — St C :x 'Ctl Early Plumbing & Heating In4, 221 Broad Street Prescott, WI 54021 P -4 1 0 W / / t t;' c N.. d d.c<,'7 ` .� f� a 6 e vc. �q ✓riw.,_. a/- T� %s is t 177Ccwt,'adf Po/'2S foa%. /fie 1 ym Lam., 2`XaD So.0 ¢�'St 4c1 N°?`1�° ssC cws 7 �^�� �eT1'� /�47��s Cor+r�0ot -tent` fio �iun,Ts S% �.�3a�rS.6 /�ibh / � ? C C l lS - � ,•� f}ltes-aj¢C aJ'ed ,s t4 �4c k es C a �� Go tzs o�.l /- s cp tsk tdhK b ✓ \°� so it IN I e C t / ^ n 1 ' T' i itch �w d e S'a C x v v S i) I Webster Soil Testing Et Sewer System Design Charlie 8 Kris Webster, Owners H5815 770 ' Street, Ellsworth, Wl 54011 Telephone: (715) 273 -3430 Pax: (715) 273 -4181 Wl Licenses: MP220673, ST220673, ST 261669, PE18803 POWTS Index Sheet Page 1 of 5 Conventional System for a 4 Bedroom Residence Property Owner/Project Name: Bill Labelle Sawdust City Development Lot 19 Eagle Bluff Subdivision Troy Township -St. Croix County Contents Page 1 of 5 Title Page Page 2 of 5 Sketch Page 3 of 5 Distribution Cell Detail Page 4 of 5 Management Plan PPa e 5 of 5 Management Plan ne %s c o Sys r A RLES L dr WEBSTER CC E- �98p,3 'j 0 ELLSWORTO i 4 . �,,�y ��OVAL E a •L & - Sit., C / 1/ ` 7eVC /O �B/' /per f'dflC O /i,.f T lG,G � �/I Sl Lt f�1' C Early Plumbing & Heating Im.. 221 Broad Street Prescott, WI 54021 W � P- I �yfoq D� = Rlr� / p tl^CC. �pwc�,'7s I.LT� �DevC. ye Yliw,z a!- - F' 4 "S F: f- p . 2 a� y pk 7'�tcaa.1.,' /fi Cdgeai / 9 M f F... f�11 Sor/ (' St 4 d� ND?` f� P �+tez R �}sr4 -,•,mod E/ _- lam- � i D r r C nr uN Cnf - to �UKTr 5� �r ��rS16 /�nTl bh Ik , 1? 4 _lI , s � � d CO, r:P4, .2 GV ta��ea cells. f{ �tehaJc d Z-t /r.sc,a, t� o a f3 sr:,,e "1 1 r l�Sp 9_l /_ SC�o tic tdh�( 7— a 1 14 . � - n i) Ct-.JS - See- oi Ce //s t-ck /7- 3 o J J C °uy ���`� c.� � sc h,e r r�iSy'�ei, - �t - d V� 1�i �c�al loi' ® 9 5 ?v c 1 syffe,ry �t �l � yt -ems. c�U' eciclr �c.if'� �� yu,c/� 7 fin �S i 0 G6sa.r .oh p.�e, S p ~OV. de /'•s.h i�i�..o -/ _� 4 Scp JI/ 7.0 F 1 • � M Y sys-tC e,l 95.E ,o< sct 3Gfio �oZ /ha�cf yG4 oY, �F{a>O(c Secti A -A CW - S) c-41 c c, L.q rlo /✓S � ,/ _ D�s•�r. � �. a d..Z`k o t`�l�•c.• Nd7�e = D. 7��,d /� tF'F� �.�' �r�F17� �`? �: Sao -_ O 7 � o ° / T , FQU�� 454' 4 P RO v/A4,o - 4s�c�. fs lq l t� U76.� L � C' �' �• t i �s T r / 1 / e1 t Gh. kd "'- G � ; � �s �!� c Q t-' e• L Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of l Division of Safety.and Buildings in accordance with Comm 85, Wis. Adm. Code County sr, c-i2o � x Attach complete site plan on paper not less (Iran 8 112 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. p percent slope, scale or dimensions, north arrow, and location and distance R awed b to nearest road. — Xa -7 -7" l Date ate Please print all information. Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Cf�ykF2lE5 5. COb} GQW —Lot NMI 114 NYC 1/4 S 1(o T 2Y N R 11 W' Property Owner's Mailing Address !Lo!t; nSubd. Name or CSM# 1 1 8'00 EAGLE $LU t� City State Zip Code Phone Number ❑ City ❑Village 0 Town Nearest Road %-A\X1 P— I MN I 55449 1 ( b3) 75 o 'Ibv.lNSvALLVy M, New Construction User Residential / Number of bedrooms 4 Code derived design flow rate 6 0 O GPD ❑ Replacement ❑ Public or commercial - Describe: Flood Plain elevation if applicable -_-- -- fl Parent material General comments 2X1� ON�FIJttt)rJftiL v J S� r r 0,'1 and recommendations: SY s� �t�URT 33,E J l I t C`�,1�`E0 �: - — — w El Boring S �0, +11 N 'Y Boring # El pit Ground surface elev. � I, q l ft. Depth to limiting factor 7 � in I Ilea ' e Horizon Depth Dominant Color Redox Description Structure Consistence Boundary '..Roots . - E -1 Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ i 0-(" C) 't z I 3-F -m mv-F 3.tf -F 1 5 018 z 6 -15 l0 ylc�z sl 1 m b d s cs ai= 0• O.b 3 I'S 3b • Ipy l — �s I i_5bK c� 0b -a F'- o.� 1.2 t f �to4Y py sl ►msbk �s 0. 2 F rn O.lo S yg 9S 7.S V2y 4 S d 1 — I F -►�' I Z [� Boring C1 3 ® Boring # Ground surface elev. 93b, z5 ft. Depth to limiting factor _ 9 b in• Pit E*Ef A lication Rate ❑ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -(o InWZ41 " rno+r ab 31)" s 0,9 2- lO -1(o t n *! — s1 1 msb m'/Fr a,s 0.6 3 a — t msbK A-::, 0.W - ,7 1.2 Ito -3b ovr2 �z Is 7.5 N tZ L4 Ill ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg /L ' Effluent #2 = BOD _< 30 mg/L and TSS <_ 30 mg/L CST Name (Please Print) S' ature — CST Number �,QV �'o I�ow.sT ., ZZ�f 5132 Address Date Evaluation Conducted Telephone Number lo- zt -ota C 15) 4zb -1-l-1S y r LET 19 Property Owner MC1tA2.Le5 (� Parcel ID It Page Z of Boring # ❑ Boring 3 Pit Ground surface elev. _ q3b. SS ft. Depth to limiting factor 9� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 - S IoV2 t _ 1 2---m 2 5-q 10V►, 2 mJkr ab ,m S 0,S 3 -NS I 11,yrzy IS I rrIsbK s aW yF M 6.1 LZ- 0 scl FD] Boring # ❑ Boring © Pit Ground surface elev. q5 ft. Depth to limiting factor �P 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 0-9 ID \1 — ( 2-f CLh :54-r- IF 0,s o.8 Z -40 I 0 3 — Is I rvxsbK JVr Ot S Zf rn 0, 1,2 3 LIO -W 10`i 4 I 1 m sb1< r aw Z-f m 0,14 6, 6 E] Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor In. El Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = 13013 :< 30 mg/L and TSS < 30 mg/L 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. SBO -8330 (R.6/00) ROVED Y OWNEV: ' CMK C H A rl Lc-s I � ZNI7: = y� LECA P7 19 rc GLE wr- 13M- # - of 0FN IL IA) HE-AT LOCh"CE(l 41"E E AW 6 OUND SuAFACE #2 -T0 OF b I W T oviAl 0 5T. NA%t- WN eOPUIAP, - TREE 1 1 sc o N s nt . Fla 5011, P ING W/ PACKHM NO COMM 65 %TDPCK PROPLEM5 C� o � 62 1 ' �2 C3 �i � IqG L N I- 0 13 O/o SLOPE ,J 1' t aA 4! i�Dt EL 9 33 r '�S� � . ELg3�g1� 0�1g6 9 3e . CC— DAIR, L'AUIrCT X � rwv t✓� �� 516W C5( v� sic. Ib , 2Z4 8 3 Z IIAr�: 16-4 -00 Ate y of y A CWTOkuk Q)Oe FOR LarS I N EKLL -E !SLUE F SUES 938. 0 i 1 � l 4 B -h 9 —P � 9-5 B 1 A / J ® I IB -19B �A T 1 9.75.4 ` .�. -�� ,,� .�� •�� ! • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page A of J FILE INFORMATION SYSTEM SPECIFICA TIONS ' Owner /71 Septic Tank Capacity 1 2S^O al ❑ NA Permit # Septic Tank Manufacturer Gli,cs'er C,Korc/ ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS �-� J v— [I NA Number of Bedrooms ❑ NA Effluent Filter Model Number of Commercial Units NA Pump Tank Capacity al NA U t? aVda Pump Tank Manufacturer ANA Estimated flow (average) (peak), Estimated x 1.5) 6 aVda .Pump Manufacturer ]i�NA Design flow (p ), C'- aVda /ft2 Pump Model �NA Soil Application Rate , Influent/Effluent Quality Monthly average* Pretreatment Unit NA ❑ Sand/Gravel Filter ❑Peat Filter Fats, Oil & Grease (FOG) 530 mg /L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality A Monthly average`* Dispersal Cell(s) Biochemical Oxygen Deman (BOD 530 mg /L Xin- ground (gravity) ❑ In- ground (pressurized) d SS <_30 m /L ❑ At -grade ❑Mound Total Suspended Solids (T SS) mg /L _ ❑Other: Fecal Coliform (geometric mean) 510' I ❑ Drip-line line Maximum Effluent Particle Size a inch diameter values typical for domestic (non- commerclal) wastewater and septic tank effluent. *� values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency At least once Inspect condition of tank(s) ev ❑ months Xyear(s) (Maximum 3 yrs.) --� Pump out contents of tanks) When combined sludge and scum equals one -third (Y,) of tank volume Inspect dispersal cell(s) At least once every ,Z ❑ months )9 year(s) (Maximum 3 yrs.) Clean effluent filter 5 M At least once every IL ,/ ❑ months fii(year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) 0 NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) WNA Other. At least once every ❑ months ❑ year(s) X NA Other. At least once every ❑ months ❑ year(s) fid 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, t NR entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with c 11 nsln Administrative The servicing of effluent filters, mechanical or pressurized POWTS components, pretreataFment components, and any er maintenance or monitoring at intervals of 12 months or less shalt be performed by a certified POWTS Maintainer. A service report shat be provided to the local regulatory authority within 10 days o co START UP AND OPERATION. 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. Page of 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 To avoid this situation have the con ents of the cell(s) and may result in mp tank removed by a e backup or surface discharge of effluent 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 orreliminabon of the following from the wastewater stream may improve the perform dental floss; pr olong t h e life of the POWTS: antibiotics; baby wipes; cigarette butts, condoms; cotton swabs; degreasers; ; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; ga soline ; grease; herbicides; meat scrap , s' medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONM F1 When the POWTS fails and/or is perm d i n cotaken ce with ch. Comm 83 3n Wisconsin'-Administrative Code: the system is properly and safely abandoned P op ening s sealed. • All piping to tanks and pits shall be disconnected and the abandoned pip e • 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 , 9 filled with soil ravel 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 area should be pro f cted utilized .K rom d and compaction and should not absorption system. The replacement 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 setback and /or soil limitations. Barring advances in POWTS technc logy a holding tank may be installed as a last re sort to r the failed POWTS. e si e h s of been luated to ' e 'fy a s u� ble re semen ar rea. If no r atl lac Xc' of e e �rr�� and S a Nt,e I atio must e p orme to to a s P reso re lace the aile OWfS. holdin nk m b install d a a last P ❑ Mound and at -grade soil absorption ye such systems must complyp following with the rules in ffect at that time. at at the infiltrative surface. Reconstructions Y <<WARNING>> TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. SEPTIC, PUMP AND OTHER TREATMENT S. DEATH MAY DO NOT ENTER A SEPTIC, P OR ROM THE N IOR TANK M YDIFFICULT I OR IMPOSSIBLE. RESULT. RESCUE OF A PER SON ADDITIONAL COMMENTS pOWTS MAINTAINER POWTS INSTALLER lw., 6 Name Name p � / �a. -E � L7 R � f- Phone '7'l,- -� , - � " � � Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Agency St Name Phone Phone 7/S This document was drafted by the staffs of the Green Lake, Marquette and Waushara County zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not GMW (2/01) guarantee the performance of the POWTS. ..w i... ... .... u.a� u uu♦ C �...y� yv VVs t ST. C SEPTIC TANK MA24MANCE AGRE1w,IGM AND OWNMIM CE MICATION FORM owmBuyer .,C.m M4j G ,' rwo`T aa,o tM o,.'J4 fl u d /3 , c►►'b M t y ,�,,, Mailing',Addroaa ' oz E sr, Ap3A48 - ox • . ( a J �b,+`�' �! X 91 9 / Pmperty Adem a 3 C JE D A 9- C o q 9 r.rdica" m rA Pimh A Zum apubm%d Citylstate 44 U 0 sa, . W.T :5 - P J 6 Pew Idm> 8caooa mi 040 T 12.2 j- to - °. coo r/ Y.00adon - ► ,., ..�.....► .K.�'l ..G.x.. 1 Subdivision F L,. jc a U F F ,, Lot N d_ CerdAed Smrvey Map t! _ - -- - _ .,, . volume Pale 0 Warranty Deed O _ '7 �9 9 ......_...� vo�maa 2- , Pap # 1-43s Spa hove. yes �o Lot m 3SYS'I'EM 8NAXC6 AND V�.l'1FiRt CEeTIF3Cre,�'IAN maiummma *mod* �e ropar at s neat t:>aatterassaw oiy�tar tept syeaxa►s te tat[ t in ip promatu• lki iurs e baa �e . Yropa d►t as eaa eftha ds At s� trot ast tMael�t stmt qt the wat di�sellsy81M Qvm tuteasaaet yop pat ipto tv"taabi$ des at %VdAed in Icomaa. 03,520) and is 13apthr is • 9L Cbtbt aowty► s aawy ordbmmm- The psoparty owner apses to ettbuit to ft Qmm Comsty Plaaoittg a Zama Daparome ■ eero5estion farn4 sips d by tin, owner sad by a nm@*pmmbwj9=9yh pm&4 tea jaw pimbw oar a Tito wed petuper YuU K% bat (t) do oa-sits Ins {Matt 1/J N of shfte. a iapsopar opmedat; visa atad/or {7) after iasspeehioa and pwnp�tta' (iitteceaaary), the septic taaJc b Vws, *A Ytidaltipwd nova road tie above ngWm mme ad spree to tttaietain the peivtts "WAV disposal byatast With the eaiaaaras W [art , theta, as sat by tit Deptt:am 4d conumm ad the Deparaeam OfNaausl Pte "Moms, Sam of wisteria. Owddludon Waft that your sapdt system has been mintsinad amst be smomed and rataaasd to the St. Qvin C4m* Plamiatt & Zontaj Dsportnaat within Jo days of am tbn+ year sepintion date. Uwe ee OV that A sattumm W bibs tots are Wu to the best of mi donr kttowWP, k*c aarhlas* the h *ma(&) *( the property described above, by vitto are svaraa a des!• re= dtd in Reddest *t D" Office. Number of Ja �. SIGNATUPW APPLICA ' DA 9 "Am i mIft rrt" that is misro pmeamed may son k is eta mWWy parfait bein4 h+troioed by to PiannitsR R Monism DaperoMM •» • hwlada with Ads applioa m it recosdad w+mwmy dsed fcoes tha Rsgitat of DOtdr QUO* ad s espy er the se eddied slarvay =W if XMIW a it enada in ON wasraaty doe& (psv. ti1d0� Z0 ' d T Stp Ztp9tpZOZ aawoml rya y 11vW Wd 60: Z0 S00Z -t,0 -100 OCT -04 -2005 14:31 FROM River Valley Abstract TO 17152351254 P.01/01 STATE BAR OF WISCONSIN FORM 1 - 1998 '7 41� S3 4 4 2� '3 U. 2 7 6 3 P 9 3 5 WARRANTY DEED KATHLEEN H. W ALSH REGISTER OF DEEDS Doeuauwn Number ST. CROIX Co., MI RECEIVED FOR RECORD Troy Pev This elOPt made lsatween _ 03/11/2005 12: 45PH eloptnent leeota t:orporatian, a 141tu Cortxlratian . Grantor. WARRANTY D EED and Matth womev and M - Marl ana9 z l I REC FEE 11.00 TRANS FEE: 449.70 Grantee. COPY FEE: Grantor, for a valuable consideration. conveys to Grant oe the following CC FEES PAGES: 1 doscrlbad real estate In St. Cr01X County. State of Wisconsin (the 'Property ") IA•uv.MV NC,1 Nam. Return Address Lot 19 - of the Plat of Eaa]. Bluff in the Town of .nd Troy, Croix County, Wiecoms n. — Matthew G. & Monique B. Twomey 5028 St. Annes Drive Subject to Declarations of Covenants, Conditions and Las Vegas, NV 89149 Restrictions for Eagle Bluff, recorded in Vol. 1589 , Page 516 , an Doc. No. 638946 as appearing in the ofliq® of the Register of Dseds for St. Croix County, Wiscomsin, and such other easements, 040- 1277 -90 -000 restrictions and reservations; of record, or in- use,, and the f obligations contained in the Frog idaNia na, h..v IM n ot Purchases Agreemeslt for this lot. This ie not st9ad proporty. (!s) (is not) Together with all appurtenant rights. title and Interests. Grantor warrants that the till+ to the Property is good, Indefeaalblo In fee slrrtplo and frog and clear or encumbrances except Dated this 9 th day or Mar h PnnS — (SEAL), (SEAL) ichard Nal t k ent w toy lopttlent rPOra am (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Minnesota Slgnatuua(s) State of VA- 3 Anokpi Count . autlwnucated this day of P Ra — rC 1 y Came bororo �Q,Q�_ -. me W. day of 1"t rT , the above named C ar a u vtzok. � e-w .e r eidr+ni- TITLE: MEMBER STATE BAR OF WISCONSIN to ( not. me known to be the person who executed the fcmgQbV authorized by 6705.06. Wis. State.) Instrument and acknowledge the same. THIS IN5TRUMENT WAS DRAFTED BY Troy I�velovntent Crration David Lamers Notary Pubtic.Sta+a- ocWluoa$M Anoka County, Minn. Charles S. Cook, President My comtnisslon is permanent. of not. state expi2tiki 9 date: (Signature• may be authenticated or acknowledged. Both are not January 31 _ ) necessary,) ' Namw of Ian.on. �fanN+p Hi �nY cqe+ ay epNl he Iyl.oJ a prlxllyd Iwbw ST tl yy(Il,uli v. STATE BAR OF WISCONSIN Mll.00rlsln tspY tttWt ca- W4• WARRANTY DEED FORM No. I - 1999 C ~ F. N0 V1%1 _N11*W9MA w�A�w,19n. 31.2009 TOTAL P.01 Parcel #: 040 - 1277 -90 -000 10/10/2005 10:30 AM PAGE 1 OF 1 Alt. Parcel #: 16.28.19.1551 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 MATTHEW G & MONIQUE B TWOMEY O - TWOMEY, MATTHEW G & MONIQUE B 5028 ST ANNES DR LAS VEGAS NV 89149 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 396 CEDAR CT SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.286 Plat: 1924 -EAGLE BLUFF 040/01 SEC 16 T28N R19W NW NW LOT 19 EAGLE Block/Condo Bldg: LOT 19 BLUFF Tract(s): (Sec- Twn -Rng 401/4 1601/4) 16- 28N -19W NW NW Notes: Parcel History: Date Doc # Vol /Page Type 03/11/2005 789409 2796/435 WD 11/12/2004 779699 2694/185 QC 09/14/2001 656632 1719/62 LC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.286 132,000 0 132,000 NO Totals for 2005: General Property 1.286 132,000 0 132,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.286 132,000 0 132,000 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 z W jVO & Nt O Q a0 O/1 j V - �C� W 0 y \ 3H1 -10 f/! 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